Which fibrinolytic agents are available for the management of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

Different fibrinolytic agents are available, and table 2, below, lists different fibrinolytic agents with some of their key characteristics. In general, fibrin-specific agents are preferred when available. Note: Streptokinase is no longer marketed in the United States.

Table 2. Fibrinolytic Agents Used in Management of STEMI. (Open Table in a new window)

Fibrinolytic Agent

Dose

Fibrin Specificity

Antigenic

Patency Rate

Non-fibrin specific

 

 

 

 

Streptokinase (no longer marketed in the US)

1.5 million units IV given over 30–60 min

No

Yes

60%–68%

Fibrin specific

 

 

 

 

Tenecteplase

(TNK-tPA)

30 mg for weight <60 kg

35 mg for 60–69 kg

40 mg for 70–79 kg

45 mg for 80–89 kg

50 mg for >90 kg

++++

No

85%

Reteplase (rPA)

10-U IV boluses given 30 min apart

++

No

84%

Alteplase (tPA)

Bolus 15 mg followed by infusion 0.75 mg/kg for 30 min (maximum 50 mg), then 0.5 mg/kg (maximum 35 mg) over the next 60 min; total dose not to exceed 100 mg.

++

No

73%-84%

IV = intravenous; rPA = recombinant human tissue plasminogen activator; STEMI = ST-elevation myocardial infarction; tPA = tissue plasminogen activator; US = United States of America.

 

Table modified from 2013 ACCF/AHA guidelines for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. [2]


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